Iris retractor

ABSTRACT

An iris retractor made of two slender elements operatively coupled via a joining mechanism, wherein each slender element has an iris grabbing hook located at its distal end; and a handle located at the proximal end of the slender element, wherein the joining mechanism is configured to endow the iris retractor with at least two configurations: a retracted configuration and an expanded configuration, wherein the length of each slender element is between 4 mm to 14 mm.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/477,558, filed Apr. 3, 2017, now U.S. Pat. No. 9,788,824, which is acontinuation of U.S. patent application Ser. No. 14/488,393, filed Sep.17, 2014, now U.S. Pat. No. 9,610,072, which is a continuation-in-partof U.S. patent application Ser. No. 13/505,510, filed May 2, 2012, nowabandoned, which is a national phase application of PCT PatentApplication No. PCT/US2010/055026, filed Nov. 2, 2010, which claimspriority to U.S. Provisional Patent Application No. 61/257,087, filedNov. 2, 2009. These applications are incorporated herein by reference intheir entirety.

FIELD OF THE INVENTION

The present invention relates generally to an iris retractor used inophthalmic surgical procedures.

BACKGROUND OF THE INVENTION

A retractor is a surgical instrument by which a surgeon can eitheractively separate the edges of a surgical incision or wound, or can holdback underlying organs and tissues, so that body parts under theincision are accessed.

The term retractor is also used to describe the distinct, hand-crankeddevices such as rib spreaders (also known as thoracic retractors, ordistractors) with which surgeons may forcefully drive tissues apart toobtain the exposure. For specialized situations such as spinal surgeryretractors have been fitted both with suction and with fiberoptic lightsto keep a surgical wound dry and illuminated.

Retractors are available in many shapes, sizes, and styles. The generalterm retractor usually describes a simple handheld steel tool possessinga curved, hooked, or angled blade fitted with a comfortable handle, thatwhen in place maintains the desired position of a given region oftissue.

There are various ophthalmic procedures that require the dilation of thepupil. For example, a lens with a cataract is typically removed from theeye by phacoemulsification. This procedure breaks up the lens typicallywith an ultrasonically driven tool. The tool has an aspiration port thataspirates the broken lens material from the patient's ocular-chamber. Itis desirable to expand the pupil during phacoemulsification to providethe surgeon with a wide view of the lens. One technique for expandingthe pupil includes pulling back or retracting the iris with what isreferred to as an iris retractor, and holding the iris at its outeredges.

SUMMARY OF THE INVENTION

The present invention seeks to provide an improved iris retractor, asdescribed in more detail hereinbelow.

There is thus provided in accordance with an embodiment of the presentinvention an iris retractor including a plurality of iris grabbing hooksdisposed or formed at a distal end of slender elements, and a proximalhandle at a proximal end of the slender elements, the slender elementsresiliently moving between retracted and expanded positions bymanipulation of the slender elements, wherein in the retracted position,the hooks are close to one another and the slender elements are close toone another, and wherein in the expanded position, the hooks areseparate and spaced apart from each other and distal portions of theslender elements are separate and spaced apart from each other.

In accordance with an embodiment of the present invention a retainingelement retains the slender elements in the expanded position until thehandle (located at the proximal portion or proximal end of a device suchas described herein) is manipulated to move the slender elements to theretracted position. In accordance with an embodiment of the presentinvention a retaining element retains the slender elements in theretracted position until the handle is manipulated to allow the slenderelements to move to the expanded position. In some of the embodiments,the retaining element comprises a spring.

In accordance with another embodiment of the present invention a portionof the retaining element is coupled to the slender element within agroove formed in proximity to a handle. In another embodiment, thehandle is received in the groove. In another embodiment, a first end ofthe retaining element is coupled to a first slender element within agroove formed in proximity to a handle and a second end of the retainingelement is coupled to a second slender element within a groove formed inproximity to a handle. In another embodiment, the handle is received inthe groove.

In accordance with an embodiment of the present invention, a retractorincludes: a first slender element and a second slender elementoperatively coupled via a joining mechanism, wherein the first slenderelement and the second slender element comprise: a grabbing hook locatedat the distal portion of the first slender element and the secondslender element; and a handle located at the proximal portion of thefirst slender element and the proximal portion of the second slenderelement, wherein the joining mechanism is configured to endow the irisretractor with at least two configuration: a retracted configuration andan expanded configuration, wherein the length of the first slenderelement and the second slender element is between 4 mm to 15 mm.

In accordance with an embodiment of the present invention, a kit isprovided, wherein the kit comprises a pair of retractors of theinvention and possibly an instruction manual.

Additionally, a method for dilating a pupil in a subject in needthereof, is provided herein. The method comprising: performing twoopposing 0.5 to 4 mm long incisions in the cornea; inserting througheach one of the incisions an iris retractor in a fully retractedconfiguration; positioning the distal end of the iris retractor behindthe iris; expanding the iris retractor; wherein the iris retractorcomprises: two slender elements operatively coupled via a joiningmechanism, wherein each slender element comprises: an iris grabbing hooklocated at the distal portion of the slender element; and a handlelocated at the proximal portion of the slender element, wherein thejoining mechanism is configured to endow said iris retractor with atleast two configuration: a retracted configuration and an expandedconfiguration, wherein the length of each slender element is between 4mm to 15 mm.

In accordance with still another embodiment of the present invention theslender elements are pivotally attached to one another at a pivot.

In accordance with an embodiment of the present invention a tip of theslender element includes a U-shaped hook with a short distal extension.

In accordance with an embodiment of the present invention a tip of theslender element extends from a proximal sleeve.

There is also provided in accordance with an embodiment of the presentinvention a method for retraction of an iris including providing an irisretractor that includes a plurality of hooks disposed or formed at adistal end of slender elements, and a proximal handle at a proximal endof the slender elements, the slender elements resiliently moving betweenretracted and expanded positions by manipulation of the handle, whereinin the retracted position, the hooks are close to one another and theslender elements are close to one another, and wherein in the expandedposition, the hooks are separate and spaced apart from each other andthe distal portions of the slender elements are separate and spacedapart from each other, inserting the slender elements in the retractedposition through a small incision near a Limbus of an eye, manipulatingthe handle to move the slender elements to the expanded position, andgrasping and retracting a portion of the iris with the hooks.

Two or more incisions each for inserting slender elements can be made ata different position than an incision for phacoemulsification.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood and appreciated more fully fromthe following detailed description taken in conjunction with thedrawings in which:

FIGS. 1A-1C are simplified perspective, top-view and side-viewillustrations, respectively, of an iris retractor, in a non-expandedorientation, constructed and operative in accordance with an embodimentof the present invention;

FIGS. 1D-1E are simplified perspective and side-view illustrations,respectively, of the iris retractor of FIGS. 1A-1C used in pairs, in thenon-expanded orientation positioned with the distal tip of retainingelement (of each retractor) within the incision at the Limbus;

FIGS. 2A-2C are simplified perspective, side-view and top-viewillustrations, respectively, of the iris retractor of FIGS. 1A-1C, in apartially expanded orientation, in accordance with an embodiment of thepresent invention;

FIGS. 3A-3C are simplified perspective, side-view and top-viewillustrations, respectively, of the iris retractor of FIGS. 1A-1C, in afully expanded orientation, in accordance with an embodiment of thepresent invention;

FIGS. 3D-3E are simplified side-view and perspective illustrations,respectively, of the iris retractor of FIGS. 3A-3C used in pairs, eachretractor is positioned within the incision with the proximal portionextending outside of the eye and the slender elements within the eye arein the fully expanded orientation (dilated iris);

FIGS. 4A-4C are simplified perspective, side-view and top-viewillustrations, respectively, of an iris retractor, in a non-expandedorientation, (such as but not limited to as when held by a designatedtool for holding and placing an iris), constructed and operative inaccordance with another embodiment of the present invention;

FIGS. 4D-4E are simplified perspective and side-view illustrations,respectively, of the iris retractor of FIGS. 4A-4C used in pairs, eachretractor is positioned within and through the incision with theproximal portion outside of the eye and the slender elements within theeye in the non-expanded orientation (such as but not limited to as whenheld by a designated tool or forceps);

FIGS. 5A-5C are simplified perspective, top-view and side-viewillustrations, respectively, of the iris retractor of FIGS. 4A-4C, in anexpanded orientation, the non restricted state, in accordance with anembodiment of the present invention;

FIGS. 5D-5E are simplified side-view and perspective illustrations,respectively, of the iris retractor of FIGS. 5A-5C used in pairs, eachretractor is positioned within the incision with the proximal portionextending outside of the eye and the slender elements within the eye(dilating the iris) in the expanded orientation;

FIGS. 6A-6B are simplified perspective, side-view and top-viewillustrations, respectively, of a pair of iris retractors, in anon-expanded orientation, (such as but not limited to as when held by adesignated tool or forceps), each retractor is constructed and operativein accordance with yet another embodiment of the present invention;

FIGS. 7A-7C are simplified perspective, top-view and side-viewillustrations, respectively, of the iris retractor of FIGS. 6A-6C, in anexpanded orientation, in accordance with an embodiment of the presentinvention;

FIGS. 7D-7E are simplified side-view and perspective illustrations,respectively, of a pair of iris retractors of FIGS. 7A-7C, eachretractor is positioned within (passed through) the incision with theproximal portion outside of the eye and the slender elements within theeye in the expanded orientation (dilated iris);

FIG. 8 is a simplified perspective illustrations of a pair of retractorseach having a U-shaped tip 70 as a hook with a short distal extension72;

FIG. 9A-9F are simplified perspective illustration of the iris retractorretractor 170, constructed and operative in accordance with anotherembodiment of the present invention. As seen first slender element areinserted through a small incision at the limbus and are manipulated bythe surgeon so that the rounded hooks 172 spread apart and retract theiris.

FIGS. 10A-10F are simplified pictorial illustrations of an irisretractor, constructed and operative in accordance with still anotherembodiment of the present invention; and

FIGS. 11A-11D are simplified pictorial illustrations of an irisretractor, constructed and operative in accordance with anotherembodiment of the present invention.

FIGS. 12A-12B are simplified pictorial illustrations of the irisretractor of FIG. 1 providing additional views and measures.

FIGS. 13A-13B are simplified pictorial illustrations of the irisretractor of FIG. 4 providing additional views and measures.

FIGS. 14A-14D are simplified pictorial illustrations of an irisretractor, constructed and operative in accordance with anotherembodiment of the present invention.

DETAILED DESCRIPTION OF EMBODIMENTS

In one embodiment, a retractor of the invention is used for retractingand/or exposing a tissue. In one embodiment, a retractor of theinvention is used for retracting and/or exposing a tissue within theeye. In one embodiment, an iris retractor of the invention is used fordilating a pupil.

In some embodiments, the joining mechanism is the spring. In someembodiments, such as but not limited to FIGS. 1-3—pre shaped arms areformed from one elastic rod—element 20 join's and position's the twoarms, In some embodiments, the arms (slender elements) expand whenextended through element 18 due to their prior designed shape, thisembodiment expanded or retracted state is self held according to thelongitudinal position of the arms in element 18. In some embodiments,such as but not limited to FIGS. 4-5 one elastic rod (such as element40)—spring expands the arms. In some embodiments, retraction is achievedby applying squeezing at elements 37 or at the proximal handles(decreasing the distance between the handles) thus closing theretractor. In some embodiments, such as but not limited to FIGS. 6-7: apivot joins the slender elements; spring (such as 60) keeps the slenderelements in an expanded orientation. In some embodiments, such as butnot limited to FIGS. 4, 5 and 9: the retractor is one piece shapedretractor.

In some embodiment, a pivot such as in FIGS. 6, 7, 10, 11 and 14 joinsthe two slender elements. In some embodiment, a pivot and a spring suchas in FIGS. 6, 7, 10, 11 and 14 joins the two slender elements. In someembodiment, at least a portion of a spring in the most proximal of aretractor as described herein. In some embodiments, a spring is a coilspring. In some embodiments, a spring is a metal spring (such as200/208/701). In some embodiments, the slender elements are elasticand/or deformable. In some embodiments, the spring is elastic and/ordeformable.

In one embodiment, provided herein an iris retractor comprising: twoslender elements operatively coupled via a joining mechanism, whereineach slender element (arm) comprises: (1) an iris grabbing hook locatedat the distal portion or distal end of the slender element (alsoreferred to as “distal hook”); and (2) a handle located at the proximalportion or proximal end of the slender element (also referred to as“proximal handle”), wherein the joining mechanism is configured to endowthe iris retractor with at least two configuration: a retractedconfiguration and an expanded configuration, wherein the length of eachslender element is between 2 mm to 18 mm. In one embodiment, eachslender element comprises one distal hook and one proximal handle.

In some embodiments, the handle is a portion of the slender element. Insome embodiments, the handle defines the proximal end of a slenderelement. In some embodiments, the handle is adapted to maintain oranchor a spring element. In some embodiments, a handle has a round shapewith a groove and/or opening (such as in FIG. 14). In some embodiments,the groove is a rounded groove. In some embodiments, the opening isconnected to the groove 0.7 mm or less. In some embodiments, the openingis 0.5 mm or less. In some embodiments, the opening is 0.15 mm or less.In some embodiments, the opening is 0.4 mm or less. In some embodiments,the opening is an insertion spot for a spring element. In someembodiments, each one of the round proximal end-handle is ear shaped. Insome embodiments, each one of the round proximal ends-handles anchorsone end of the spring element. In some embodiments, the handle is agroove with an opening wherein the groove anchors one end of the spring.In some embodiments, the proximal end of the retractor is the spring.

In some embodiments, the length of each slender element is between 3 mmto 16 mm. In some embodiments, the length of each slender element isbetween 5 mm to 15 mm. In some embodiments, the length of each slenderelement is between 4 mm to 14 mm. In some embodiments, the length of theslender elements with one retractor is the same.

In another embodiment, provided herein an iris retractor comprising: twoslender elements coupled via a pivot (such as but not limited to element705), wherein each slender element (arm) comprises: (1) an iris grabbinghook located at the distal end of the slender element; and (2) a handlelocated at the proximal end of the slender element, wherein the irisretractor is normally, naturally, and/or by default (no exertion offorce) is in an expanded configuration, wherein the length of eachslender element is between 4 mm to 15 mm.

In another embodiment, provided herein an iris retractor comprising: twoslender elements coupled via a pivot, wherein each slender element (arm)comprises: (1) an iris grabbing hook (such as formed by teeth 703 and704) located at the distal end of the slender element; and (2) a handlelocated (such as but not limited to handle 707) at the proximal end ofthe slender element, wherein a spring coupled to the proximal end orportion of the slender elements maintains the retractor in a an expandedconfiguration, wherein the length of each slender element is between 4mm to 15 mm.

Reference is now made to FIGS. 1A-3C, which illustrate an iris retractor10, constructed and operative in accordance with a non-limitingembodiment of the present invention.

Iris retractor, in some embodiments, includes a grabbing hook endingeach slender element at its proximal end (such as element 12 (FIGS.2A-3C)) disposed or formed at a distal end or portion of one or moreslender elements 14. In another embodiment, a grabbing hook protrudes0.1 mm to 1.5 mm laterally from the lateral surface of the slenderelement. In another embodiment, a grabbing hook protrudes 0.25 mm to 1.5mm laterally from the lateral surface of the slender element. In anotherembodiment, a grabbing hook protrudes 0.5 mm to 1.2 mm laterally fromthe lateral surface of the slender element.

In another embodiment, the distal end of a grabbing hook protrudesoutwardly from the expansion plane of the retractor. In anotherembodiment, the expansion plane of the retractor is the plane ofretraction. In another embodiment, the distal end of a grabbing hookprotrudes inwardly from the expansion plane of the retractor. In anotherembodiment, the distal end of a grabbing hook protrudes perpendicularlyfrom the expansion plane of the retractor. In another embodiment, thedistal end of a grabbing hook protrudes up to 90° from the expansionplane of the retractor. In another embodiment, the distal end of agrabbing hook protrudes up to 80° from the expansion plane of theretractor. In another embodiment, the distal end of a grabbing hookprotrudes up to 70° from the expansion plane of the retractor. Inanother embodiment, the distal end of a grabbing hook protrudes up to60° from the expansion plane of the retractor. In another embodiment,the distal end of a grabbing hook protrudes up to 50° from the expansionplane of the retractor. In another embodiment, the distal end of agrabbing hook protrudes at least 30° from the expansion plane of theretractor. In another embodiment, the distal end of a grabbing hookprotrudes at least 40° from the expansion plane of the retractor. Inanother embodiment, the distal end of a grabbing hook protrudes at least50° from the expansion plane of the retractor. In another embodiment,the distal end of a grabbing hook protrudes at least 60° from theexpansion plane of the retractor. In another embodiment, the distal endof a grabbing hook protrudes at least 70° from the expansion plane ofthe retractor.

In another embodiment, the maximal distance between the distal ends ofthe slender elements is 10 mm. In another embodiment, the maximaldistance between the distal ends of the slender elements is 9 mm. Inanother embodiment, the maximal distance between the distal ends of theslender elements is 7 mm. In another embodiment, the maximal distancebetween the distal ends of the slender elements is 6 mm. In anotherembodiment, the maximal distance between the distal ends of the slenderelements is 5 mm. In another embodiment, the maximal distance betweenthe distal ends of the slender elements is 4 mm. In another embodiment,the maximal distance is obtained in the fully expanded position of theretractor.

In another embodiment, the distal end of a grabbing hook is the distalend of the retractor. In another embodiment, the distal portion of theretractor is a portion of the retractor extending from the joiningmechanism, pivot, and/or spring to the distal end of the retractor.

In another embodiment, a grabbing hook defines a niche having a maximaldepth 0.1 mm to 1.8 mm. In another embodiment, a grabbing hook defines aniche having a maximal depth 0.1 mm to 1.5 mm. In another embodiment, agrabbing hook defines a niche having a maximal depth 0.3 mm to 1.2 mm.In another embodiment, a grabbing hook defines a niche having a maximaldepth 0.5 mm to 1 mm.

In the illustrated embodiment, there are two slender elements (such asbut not limited to 14). The slender elements 14 are arranged to movethrough a retaining element 16 from a fully retracted position (FIGS.1A-1C) to a partially expanded position (FIGS. 2A-2C) to a fullyexpanded position (FIGS. 3A-3C). A proximal portion 18 of retainingelement 16 is formed with a groove 19. The proximal ends of slenderelements 14 terminate in a proximal handle 20. The slender elements 14may be joined as a single element before connection to handle 20 or maybe joined at the handle 20. In the fully expanded position, handle 20 ispushed completely into groove 19 and is squeezed and held in thisposition by the side walls of groove 19. (Alternatively, handle 20 may“click” into groove 19. Accordingly, there can be a fixed configuration,wherein handle 20 clicks into groove 19 and slender elements 14 have afixed expansion, or an adjustable expansion configuration, wherein themore the slender elements 14 are inserted into the eye (such as proximalportion 18) the larger is their lateral expansion. Retaining element 18retains slender elements 14 in the retracted position until handle 20 ispushed towards groove 19. In one embodiment, the slender elements areretained by element 18 and are formed to expand.

Slender elements 14 and hooks 12 may be constructed of a metal orplastic wire, such as but not limited, NITINOL or stainless steel or amedically safe plastic with suitable resilience, e.g., a shape memorypolymer plastic.

In another embodiment, a retractor of the invention comprises two joinedslender elements. In another embodiment, joined slender elements aredirectly or indirectly joined. In another embodiment, joined slenderelements are joined by a pivot. In another embodiment, joined slenderelements are joined by a spring. In another embodiment, the spring is aspring retaining element. In another embodiment, a spring retainingelement retains the retractor in an expanded configuration/position. Inanother embodiment, upon exertion of force which brings the slenderelements into proximity (non-expanded to retracted position) thedistance between the attachment points of the spring within the slenderelements-shortens. In another embodiment, upon exertion of force whichbrings the slender elements into proximity (non-expanded to retractedposition) the spring bends. In another embodiment, joined slenderelements are joined by a pivot and/or a spring. In another embodiment,joined is joined at the proximal portion of the slender elements. Inanother embodiment, the length of a slender element is divided to 2equal (in length) parts a “proximal portion” (adjacent to the handle)and a “distal portion” (adjacent to the iris grabbing tooth or hook).

In another embodiment, the retractor described herein substantiallyreduces the medical complications associated with intraocular surgery.In another embodiment, the retractor described herein substantiallyreduces the medical complications associated with cataract surgery.

In another embodiment, the retractor described herein is utilized forpupil dilation, based on a concept different than any other device inthe market. In another embodiment, the invention is utilized by using apair of retractors which are inserted through two 19 Gauge or 0.3-5 mmside-port incisions, typically placed one opposite to the other. Inanother embodiment, the invention is utilized by using a pair ofretractors which are inserted through two 19 Gauge or 0.3-3.5 mmside-port incisions, typically placed one opposite to the other.

In another embodiment, each retractor is inserted with its two arms(also referred to a “slender elements”) firmly closed, in a fullyretracted configuration using designated forceps. In another embodiment,the bulge (also referred to as ear) within each slender element is usedfor securing and/or anchoring a retractor of the invention to forceps(utilized for insertion of the retractor into the eye. In anotherembodiment, each of the grabbing hooks anchor a pupillary margin. Inanother embodiment, once the slender elements (two arms) of theretractor are in position, the forceps are gently released to allow asmooth and control opening of the retractor to a fully expandedconfiguration. In another embodiment, this release of the retractedconfiguration to the expanded configuration results in dilating thepupil to create a 2×2 to 12×12 mm quadrangular opening. In anotherembodiment, this release of the retracted configuration to the expandedconfiguration results in dilating the pupil to create a 3×3 to 10×10 mmquadrangular opening. In another embodiment, the quadrangular opening is6×6 mm+/−40%.

In another embodiment, provided herein a method for dilating a pupil ina subject in need thereof, comprising: (a) performing two opposing 0.5to 4 mm long incisions in the cornea; (b) inserting through each one ofthe 0.5 to 4 mm long incisions an iris retractor in a fully retractedconfiguration; (c) positioning the distal end of the iris retractorbehind the iris; (d) expanding the iris retractor (by releasing the gripfrom the forceps and allowing the expansion of the retractor); whereinthe iris retractor comprises: two slender elements operatively coupledvia a joining mechanism, wherein each slender element comprises: an irisgrabbing hook located at the distal portion of said slender element; anda handle located at the proximal portion of the slender element, whereinthe joining mechanism is configured to endow the iris retractor with atleast two configuration: a retracted configuration and an expandedconfiguration, wherein the length of each slender element is between 4mm to 15 mm.

In some embodiments, “positioning the distal end” includes partialexpansion of the retractor. In some embodiments, “expanding the irisretractor” is fully expanding the iris retractor. In some embodiments,the actual degree of “fully expanding” is dependent on tissue expansionresistance of the iris or the retractor's mechanical limitation.

In another embodiment, provided herein a method for dilating a pupil ina subject in need thereof, comprising: (a) performing two opposing 0.5to 4 mm long incisions in the cornea; (b) inserting through each one ofthe 0.5 to 4 mm long incisions an iris retractor in a fully retractedconfiguration; (c) positioning the distal end of the iris retractorbehind the iris; (d) expanding said iris retractor; wherein the irisretractor comprises: two slender elements operatively connected to oneanother.

In another embodiment, surgical maneuvers can then be performed usingroutine techniques under direct visualizations. In another embodiment,at the end of the surgery both retractors are removed using theforceps—the slender elements (two arms) are pushed to a fully retractedconfiguration and the retractor is simply pulled out via theaforementioned incision.

In another embodiment, the location of the side port incisionsdetermines the shape of the pupillary opening. In another embodiment,asymmetrical, non-opposite, location of the incisions results in atrapezoidal opening with its wider base facing the surgeon (thisprovides a wide “device free” area in which the slender elements do notimpede with the access of surgical instruments.

In another embodiment, side port incisions are done parallel to the irisplan. In another embodiment, the grabbing hooks are bent backward(protrude laterally). In another embodiment, the slender elements areonly partially expanded to approximately the diameter of the constrictedpupil, the grabbing hooks are positioned properly behind the iris andonly then the device is released to its full expansion.

In another embodiment, a device is released to its full expansion and/orextension is a fully expanded device. In another embodiment, expansionof the device is forced by the spring. In another embodiment, thespring's force is smaller than the tissue's tearing force. In anotherembodiment, the spring's force is smaller than the cornea's tearingforce.

In another embodiment, the distance between the distal ends of a fullyexpanded retractor is 4 to 15 mm. In another embodiment, the distancebetween the distal ends of a fully expanded retractor is 4 to 12 mm. Inanother embodiment, the distance between the distal ends of a fullyexpanded retractor is 5 to 10 mm. In another embodiment, the distancebetween the distal ends of a fully expanded retractor is 5.5 to 8 mm. Inanother embodiment, the distance between the distal ends of a fullyexpanded retractor is 2.5 to 6 mm.

In another embodiment, the spring's force is 0.4 to 25 grams. In anotherembodiment, the spring's force is 0.5 to 20 grams. In anotherembodiment, the spring's force is 1 to 15 grams. In another embodiment,the spring's force is 1.5 to 15 grams. In another embodiment, thespring's force is 1 to 15 grams. In another embodiment, the spring'sforce is 1.5 to 6 grams.

In another embodiment, the spring's force is 1 to 10 grams when thedistance between the distal ends of the retractor is 4 to 10 mm. Inanother embodiment, the spring's force is 1 to 8 grams when the distancebetween the distal ends of the retractor is 5 to 8 mm. In anotherembodiment, the spring's force is 3 to 10 grams when the distancebetween the distal ends of the retractor is 5 to 7 mm. In anotherembodiment, the spring's force is 4 to 9 grams when the distance betweenthe distal ends of the retractor is 4 to 7 mm. In another embodiment,the spring's force is 5 to 14 grams when the distance between the distalends of the retractor is 4 to 6 mm. In another embodiment, the spring'sforce is 5 to 11 grams when the distance between the distal ends of theretractor is 3.5 to 5 mm. In another embodiment, the spring's force is 5to 14 grams when the distance between the distal ends of the retractoris 3 to 4.5 mm. In another embodiment, the spring's force is 5 to 12grams when the distance between the distal ends of the retractor is 3 to4 mm. In another embodiment, the spring's force is 6 to 16 grams whenthe distance between the distal ends of the retractor is 3 to 3.8 mm. Inanother embodiment, the spring's force is 7 to 13 grams when thedistance between the distal ends of the retractor is 3.3 to 3.8 mm. Inanother embodiment, the spring's force is 8 to 16 grams when thedistance between the distal ends of the retractor is 2.7 to 3.8 mm. Inanother embodiment, the spring's force is 8 to 14 grams when thedistance between the distal ends of the retractor is 2.7 to 3.8 mm.

In another embodiment, in case a slender element is not positionedproperly, it is repositioned by maneuvering the external part of thesame slender element. In another embodiment, the retractor of theinvention spares the need to perform any intraocular manipulationduring: insertion, reposition, or removal of the retractor.

In another embodiment, a pair of retractors for dilating a pupil wereused in a variety of medical cases including: pseudoexfoliationsyndrome, uveitic cataract, post glaucoma filtration surgery, mature andhypermature densed nuclear cataract, patients with clinical IFIS,secondary implantation of PC-IOLs in aphakic eyes, and operationscombined with pars plana vitrectomy.

In another embodiment, a surgery performed with a pair of retractors asdescribed herein are performed in superior, lateral and/or obliqueapproaches according to surgeons' preference. In another embodiment, aretractor as described herein is made of a medical grade material suchas metal and/or plastic.

In one embodiment, a spring includes a first end and a second end,wherein a first end of a spring is coupled to the proximal portion of afirst slender element and a second end of a spring is coupled to a theproximal portion of a second slender element. In another embodiment, anend of the spring is coupled, connected, and/or fixed to a springreceiving groove located within a proximal portion of a slender element.In another embodiment the spring is an extension of the proximal ends ofthe slender elements. In another embodiment, the spring receiving grooveis located within or in proximity to a handle located in the proximalportion of each slender element. In another embodiment, a springconnects the slender elements. In another embodiment, a spring is aflexible clip.

In one embodiment, a portion of the retaining element is coupled to theslender element within a groove formed in proximity to a handle. Inanother embodiment, the handle is received in the groove. In anotherembodiment, a first end of the retaining element is coupled to a firstslender element within a groove formed in proximity to a handle and asecond end of the retaining element is coupled to a second slenderelement within a groove formed in proximity to a handle. In anotherembodiment, the handle is received in the groove.

In one embodiment, a spring retains the retractor in an expandedposition. In one embodiment, the expanded position is the defaultposition. In one embodiment, the retractor is adjusted to a non-expandedposition be exerting force on the proximal ends of the slender elementswhich brings the proximal portion of each slender element intoproximity, and the distal portion of the slender elements intoproximity. In one embodiment, the retractor is adjusted to anon-expanded position be exerting force which brings the proximalportions of the two slender elements closer to one another. In oneembodiment, the retractor is adjusted to a retracted position byexerting force which brings a proximal portion of the two slenderelements into contact. In another embodiment, the phrase “a non-expandedposition” is synonymous with the phrase “a non-retracted position”. Inone embodiment, “a non-expanded position” and “a non-retracted position”is any position between the retracted position and expanded position. Inone embodiment, a retracted position is a position wherein an angleformed between the slender elements is zero or close to zero. In oneembodiment, an expanded position is a position wherein an angle formedbetween the slender elements is the maximal angle reachable by an intactretractor of the invention. In one embodiment, an expanded position is aposition wherein an angle formed between the slender elements is 90° ormore. In another embodiment, the terms “position” and “configuration”are used interchangeably.

In another embodiment, the spring loaded is a biasing means and/or aretaining means, such as but not limited to a coil spring or a flexibleband or rod.

FIGS. 1D-1E illustrate a pair of iris retractors 10 in a non-expandedorientation (i.e., retracted position). A portion of the slender element(such as 18) abuts against the cornea 22, in proximity of up to 8 mmfrom the limbus 23. As seen in the figures, iris retractor 10 isinserted through a small incision (e.g., 0.5-4.5 mm incision) near thelimbus 23.

In some embodiments, the pivot is the narrowest portion of the irisretractor.

Bringing or squeezing the handles into proximity results in movement theslender elements towards one another—a retracted or a closed position.As seen in FIGS. 3D-3E, hooks (such as 12) grab and hook onto the iris24 and retract the iris 24 for exposing the lens 25 to provide a goodworking opening for the surgeon.

The spring anchors and/or holds the retractor in an expanded position byapplying a counter force on the outside of the limbus and keeping theretractor in an expanded configuration.

Hooks (such as 12) are separate and spaced apart from each other upondistal movement of slender elements. Thus, a single iris retractorprovides spaced apart retraction points, as opposed to some prior artiris retractors which only work at a single point. In anotherembodiment, the present invention requires 2 iris retractors forproviding a proper opening to the surgeon. In another embodiment, thepresent invention requires 2 iris retractors for providing a propersquare shaped opening to the surgeon. In another embodiment, the presentinvention requires 2 iris retractors for providing a proper rectangleshaped opening to the surgeon.

In another embodiment, the invention provides a kit comprising two ormore iris retractor assemblies. In one embodiment, the inventionprovides a kit comprising: one or more iris retractor assemblies; aholder comprising one or more iris retractor assemblies or holdingassemblies (the holding assemblies are configured to hold one or moreiris retractor assemblies).

In some embodiment, a pair of iris retractors as described herein isused in kits and in medical procedures as described herein. In anotherembodiment, an iris retractor is inserted in a non-expanded orientation(i.e., retracted position) and then placed within the eye.

In another embodiment, in a fully retracted position the total width ofthe slender elements in each iris retractor (FIGS. 1A-1C) is less than 3mm wide. In another embodiment, the total with of the slender elementsin a fully retracted position (FIGS. 1A-1C) is less than 2.5 mm wide. Inanother embodiment, the total with of the slender elements in a fullyretracted position (FIGS. 1A-1C) is less than 2 mm wide. In anotherembodiment, in a fully retracted position the total width of the slenderelements enables the insertion of an iris retractor through a smallincision in the limbus. In another embodiment, the small incision is 0.5to 3.5 mm wide or long, 0.8 to 2.5 mm wide or long, or 0.7 to 1.8 mmwide or long.

In some embodiment, FIGS. 1 and 2 further describe a device of theinvention similar to the device of FIG. 1. In some embodiment, a hook asdescribed herein includes a proximal end such as element 703 (FIG. 14A)or element “a” in FIG. 12A, B and FIG. 13A, B. In some embodiment, ahook as described herein includes a midpoint such as element “b” in FIG.12A, B and FIG. 13A, B. In some embodiment, a hook as described hereinincludes a distal end such as element 704 (FIG. 14A) or element “c” inFIG. 12A, B and FIG. 13A, B.

In some embodiment, a hook has an outer length of 0.1 to 2 mm long suchas but not limited to “z” in FIG. 12A. In some embodiment, a hook has anouter length of 0.3 to 1 mm long such as but not limited to “z” in FIG.12A. In some embodiment, a hook is 0.1 to 2 mm deep such as but notlimited to “y” in FIG. 12A. In some embodiment, a hook is 0.3 to 1.2 mmdeep such as but not limited to “y” in FIG. 12A.

In another embodiment, a pair of iris retractors is utilized in variousophthalmic procedures that require the dilation of the pupil. Forexample, a lens with a cataract is typically removed from the eye byphacoemulsification. In another embodiment, a pair of iris retractors isinserted (each retractor is inserted separately) into an affected eyethus extending/expanding the pupil during phacoemulsification therebyproviding the surgeon with a wide view of the lens. In anotherembodiment, expanding and/or extending the pupil is retracting the iriswith what is referred to as an iris retractor, and holding the iris atits outer edges. In another embodiment, the slender elements are adaptedto expand and/or extend the pupil. In another embodiment, the distalends of the two slender elements are adapted to expand and/or extend thepupil and/or hold the iris at its outer edges. In another embodiment,the proximal handles are not inserted through the limbus incision. Inanother embodiment, the total width of the proximal handles is more than2 mm wide. In another embodiment, the total width of the proximalhandles is more than 2.5 mm wide. In another embodiment, the total widthof the proximal handles is more than 3 mm wide. In another embodiment,the total width of the proximal handles is more than 3.5 mm wide. Inanother embodiment, the total width of the proximal handles is more than4 mm wide. In another embodiment, the total width of the proximalhandles is 2 to 5 mm wide.

Reference is now made to FIGS. 4A-5E, which illustrate an iris retractor30, constructed and operative in accordance with another embodiment ofthe present invention.

Iris retractor 30 includes a plurality of hooks 32 disposed or formed ata distal end of one or more slender elements 34. In the illustratedembodiment, there are two slender elements 34. The proximal ends ofslender elements 34 terminate in a proximal handle 40. Handle 40 andslender elements 34 are made of a resilient, flexible material (e.g.,metal or plastic) to form a kind of resilient tweezers or pliers.

FIGS. 4D-4E illustrate a pair of iris retractors 30 in a non-expandedorientation (i.e., retracted position) placed on the eye. A portion ofretaining element 36 (36 is the narrow neck positioned within theincision, its proximal part widens when expanded and abuts against thelimbus) abuts against the cornea 22, typically but not necessarily atthe limbus 23.

Handle (such as element 40) releases the slender element 34 that isinitially caught in groove 38 of retaining element 36. (For the otheroption mentioned above, iris retractor 30 moves to the expanded positionby releasing elements 37.) By virtue of their resilience, slenderelements 34 spring outwards to the expanded position in FIGS. 5A-5E. Asseen in FIGS. 4A-5E, the geometry of iris retractor 30 enables expansionof hooks 32. In some embodiments, handle 40 is the spring that expandsslender element 34. In some embodiments, groove 38 is the narrow neckthat remains narrow following expansion in order not to lengthen theincision. In some embodiments, the devices is retracted using a tool anddoes not have a retracted holding function.

As seen in FIGS. 5D-5E, hooks 32 grab and hook onto the iris 24 andretract the iris 24 for exposing the lens 25 to provide a good workingopening for the surgeon.

Reference is now made to FIGS. 6A-7E, which illustrate a pair of irisretractors 50, each retractor is constructed and operative in accordancewith yet another embodiment of the present invention.

Iris retractor 50 includes a plurality of hooks 52 disposed or formed ata distal end of one or more slender elements 54. In the illustratedembodiment, there are two slender elements 54, which pivot about a pivot56. The proximal ends of slender elements 54 terminate in a proximalhandle 60. Handle 60, pivot 56 and slender elements 54 form a kind ofscissors.

FIGS. 6A-6B illustrate a pair of iris retractors 50 in a non-expandedorientation (i.e., retracted position) placed within the incision, withtheir slender element within the tissue while the proximal handlesremain and/or protrude outside. A portion of iris retractor 50 (e.g.,near the pivot 56) abuts against the cornea 22, typically but notnecessarily at the limbus 23.

Manipulating handle 60 “scissors out” the slender elements 54 to theexpanded position in FIGS. 7A-7E. As seen in FIGS. 7D-7E, hooks 52 graband hook onto the iris 24 and retract the iris 24 for exposing the lens25 to provide a good working opening for the surgeon. A portion of irisretractor 50 (e.g., near the pivot 56) anchors the retractor 50 byapplying a counter force on the outside of the limbus 23.

Reference is now made to FIG. 8 which illustrate different tips for theiris retractor of any of the above embodiments, in accordance withdifferent embodiments of the present invention. In FIG. 8, a tip 70 isshown that has a U-shaped hook with a short distal extension 72.

Iris retractor may include a plurality of hooks disposed or formed atdistal ends of the slender elements. A slender element, according tosome embodiments, may be adjustable in length.

Reference is now made to FIGS. 9A-9F, which illustrate an iris retractor170, constructed and operative in accordance with another embodiment ofthe present invention. As seen first slender element are insertedthrough a small incision at the limbus and are manipulated by thesurgeon so that the rounded hooks spread apart and retract the iris.

Iris retractor 170 includes a plurality of hooks 172 disposed or formedat a distal end of one or more slender elements 174. In the illustratedembodiment, there are two slender elements 174. The proximal ends ofslender elements 174 terminate in a proximal spring (such as 176).Handle/spring 176 and slender elements 174 are made of a resilient,flexible material (e.g., metal or plastic) to form a kind of resilienttweezers or pliers. The hooks 172 in this embodiment curve back ontoslender elements 174 and may optionally abut against slender elements174. In a non-expanded orientation a pair of iris retractors areinserted through a small incision at the limbus. In some embodiments,iris retractor 170 in an expanded orientation, the hooks 172 grab andhook onto the iris and retract the iris for exposing the lens to providea good working opening for the surgeon.

Reference is now made to FIGS. 10A-14F, which illustrate an irisretractor 190, constructed and operative in accordance with anotherembodiment of the present invention.

Iris retractor 190 includes a plurality of hooks 192 disposed or formedat a distal end of one or more slender elements 194. In the illustratedembodiment, there are two slender elements 194. The proximal ends ofslender elements 194 terminate in a proximal handle 196. Handle 196 andslender elements 194 are made of a resilient, flexible material (e.g.,metal or plastic or shape memory) to form a kind of resilient tweezersor pliers. Handle 196 in this embodiment is sufficiently resilient suchthat it flattens into an oblong shape when squeezed, as seen in FIG.10B. Handle 196 springs back to its original shape to move irisretractor 190 to the expanded orientation.

An iris retractor in a non-expanded orientation is inserted through asmall incision at the limbus in some embodiments. As mentioned before,handle 196 flattens into an oblong shape. FIG. 10F illustrates irisretractor 190 in an expanded orientation, wherein hooks (element 192 in10A) grab and hook onto the iris 24 and retract the iris 24 for exposingthe lens to provide a good working opening for the surgeon.

Reference is now made to FIGS. 14A-14D, which illustrate an irisretractor 700, constructed and operative in accordance with anotherembodiment of the present invention. In some embodiments, the irisretractor is composed of two slender elements (702) joined by a pivot(705) and a spring at the proximal end (proximal spring 701). In someembodiments, each slender element ends with a hook formed by two teethor extensions (703 and 704). In another embodiment, a tissue to beretracted according to the invention is placed in-between extensions(703 and 704) in groove 707. In another embodiment, a tissue to beretracted according to the invention is anchored in-between extensions(703 and 704). In another embodiment, a tissue to be retracted accordingto the invention is placed over tooth 703 and under tooth 704. Inanother embodiment, a tissue to be retracted according to the inventionis placed over tooth 704 and under tooth 703.

In one embodiment, provided herein an iris retractor comprising: a onepiece elastic rod, formed/shaped as a double side by side “L” coupledforms, comprising two slender elements operatively coupled via theproximal section, wherein each slender element (arm) comprises: (1) aniris grabbing hook located at the distal portion or distal end of theslender elements; and (2) a handle located at the proximal portion orproximal end of each of the slender element; and optionally (3) aretaining element, wherein the retaining element is configured to endowthe iris retractor with at least two configuration: a retractedconfiguration and an expanded configuration

In some embodiments, a hook is a rounded hook or a crescent-like hook(such as but not limited to element 12 in FIG. 2, FIG. 3, element 192 inFIG. 10. In some embodiments, a hook is bended towards the eye orinwardly such as described herein (see FIG. 3A and/or element 32 in FIG.5B). In some embodiments, a hook is fully rounded such as in element 172in FIG. 9.

Reference is now made to FIGS. 11A-11D, which illustrate an irisretractor 200, constructed and operative in accordance with anotherembodiment of the present invention.

Iris retractor 200 includes a plurality of hooks disposed or formed at adistal end of one or more slender elements. In the illustratedembodiment, there are two slender elements joined by a spring distal tothe pivot. The proximal ends of slender elements form a proximal handlethat includes two scissor handles. The spring may be loaded by a biasingdevice, such as a coil spring which has ends attached to each one of theslender elements.

FIG. 11B illustrates iris retractor 200 in a non-expanded orientationinserted through a small incision at the limbus 23. Handles are squeezedand held together so that slender elements are retracted together, asshown in FIG. 11. FIG. 11 illustrates iris retractor 200 in an expandedorientation, wherein hooks grab and hook onto the iris 24 and retractthe iris 24 for exposing the lens to provide a good working opening forthe surgeon.

In another embodiment, the phrases “iris retractor” and “iris retractorassembly” are used interchangeably.

In another embodiment the maximal distance between hooks in a fullyexpanded retractor is 12 mm. In another embodiment the maximal distancebetween hooks in a fully expanded retractor is 11 mm. In anotherembodiment the maximal distance between hooks in a fully expandedretractor is 10 mm. In another embodiment the maximal distance betweenhooks in a fully expanded retractor is 9 mm. In another embodiment themaximal distance between hooks in a fully expanded retractor is 8 mm. Inanother embodiment the maximal distance between hooks in a fullyexpanded retractor is 7 mm. In another embodiment the maximal distancebetween hooks in a fully expanded retractor is 6.5 mm. In anotherembodiment the maximal distance between hooks in a fully expandedretractor is 4 to 6.5 mm.

In some embodiments, the maximal length of slender element of irisretractor is measured from protruding ear to distal tooth or. In someembodiments, the length of each one of the slender elements is 3.5 to 15millimeters (mm). In some embodiments, the length of each one of theslender elements is 4.05 to 12.3 millimeters (mm). In some embodiments,the length of each one of the slender elements is 5.5 to 11 mm. In someembodiments, the length of each one of the slender elements is 7 to 9.5mm. In some embodiments, the length of each one of the slender elementsis 8 to 8.8 mm. In some embodiments, the length of each one of theslender elements is 8.1 to 8.3 mm.

In another embodiment, the portion of said slender element extendingfrom the pivot to the distal end (distal tooth) is between 1.5 mm to 8mm. In some embodiments, the length of slender element 102 of irisretractor from pivot member to distal end (such as distal tooth) is 2.55to 7.8 mm. In some embodiments, the length of slender element of irisretractor from pivot member to distal end is 3 to 7 mm. In someembodiments, the length of slender element of iris retractor from pivotmember to distal end is 3.5 to 6.5 mm. In some embodiments, the lengthof slender element of iris retractor 100 from pivot member to distal endis 4.3 to 5.8 mm. In some embodiments, the length of slender element ofiris retractor from pivot member to distal end is 5 to 5.4 mm.

In another embodiment, the maximal length of slender element of irisretractor from pivot member to distal end is at least 30% of the entirelength of the slender element. In another embodiment, the maximal lengthof slender element of iris retractor from pivot member to distal end isat least 35% of the entire length of the slender element. In anotherembodiment, the maximal length of slender element of iris retractor frompivot member to distal end is at least 40% of the entire length of theslender element. In another embodiment, the maximal length of slenderelement of iris retractor from pivot member to distal end is at least45% of the entire length of the slender element. In another embodiment,the maximal length of slender element of iris retractor from pivotmember to distal end is at least 50% of the entire length of the slenderelement. In another embodiment, the maximal length of slender element ofiris retractor from pivot member to distal end is at least 55% of theentire length of the slender element. In another embodiment, the maximallength of slender element of iris retractor from pivot member to distalend is at least 60% of the entire length of the slender element. Inanother embodiment, the maximal length of slender element of irisretractor from pivot member to distal end is at least 65% of the entirelength of the slender element. In another embodiment, the maximal lengthof slender element of iris retractor from pivot member to distal end isat least 70% of the entire length of the slender element.

In another embodiment, the maximal width along the portion of a slenderelement extending from the pivot to the distal end is 2.5 mm. and keep1.5 mm, 1.1, 1 to preferred. In another embodiment, the maximal widthalong the portion of a slender element extending from the pivot to thedistal end is 2 mm. In another embodiment, the maximal width along theportion of a slender element extending from the pivot to the distal endis 1.8 mm. In another embodiment, the maximal width along the portion ofa slender element extending from the pivot to the distal end is 1.5 mm.In another embodiment, the maximal width along the portion of a slenderelement extending from the pivot to the distal end is 1.3 mm. In anotherembodiment, the maximal width along the portion of a slender elementextending from the pivot to the distal end is 1 mm. In anotherembodiment, the width along the portion of a slender element extendingfrom the pivot to the distal end is 0.5 mm to 2 mm. In anotherembodiment, the maximal width along the portion of a slender elementextending from the pivot to the distal end is at the distal tooth (alsoreferred to as iris grabbing hook).

In another embodiment, the grabbing hook protrudes laterally 0.25 mm to1.2 mm from the lateral surface of a slender element at its distal end(see 188 in FIG. 14 B). In another embodiment, the grabbing hookprotrudes laterally 0.4 mm to 1.0 mm from the lateral surface of aslender element at its distal end. In another embodiment, the grabbinghook protrudes laterally 0.5 mm to 0.8 mm from the lateral surface of aslender element at its distal end. In another embodiment, the grabbinghook protrudes laterally 0.5 mm to 0.7 mm from the lateral surface of aslender element at its distal end.

In some embodiments, the minimal width of a portion of slender elementof iris retractor extending from pivot member to the proximal end is 0.9mm. In some embodiments, the minimal width of a portion of slenderelement of iris retractor extending from pivot member to the proximalend is 0.8 mm. In some embodiments, the minimal width of a portion ofslender element of iris retractor extending from pivot member to theproximal end is 0.7 mm. In some embodiments, the minimal width of aportion of slender element of iris retractor extending from pivot memberto the proximal end is 0.6 mm. In some embodiments, the minimal width ofa portion of slender element of iris retractor extending from pivotmember to the proximal end is 0.5 mm. In some embodiments, the minimalwidth of a portion of slender element of iris retractor extending frompivot member to the proximal end is 0.4 mm. In some embodiments, theminimal width of a portion of slender element of iris retractorextending from pivot member to the proximal end is 0.3 mm. In someembodiments, the minimal width of a portion of slender element of irisretractor extending from pivot member to the proximal end is 0.25 mm. Insome embodiments, the minimal width of a portion of slender element ofiris retractor extending from pivot member to the proximal end is 0.15mm.

In some embodiments, the distance between the inner edges of proximalteeth of iris retractor when slender element is in a maximal extendedorientation, equals to 2.9 to 9.3 mm. In some embodiments, the distancebetween the inner edges of proximal teeth of iris retractor when slenderelement is in a maximal extended orientation, equals to 3.6 to 8.5 mm.In some embodiments, the distance between the inner edges of proximalteeth of iris retractor when slender element is in a maximal extendedorientation, equals to 4.3 to 7.7 mm. In some embodiments, the distancebetween the inner edges of proximal teeth of iris retractor when slenderelement is in a maximal extended orientation, equals to 5.05 to 6.95 mm.In some embodiments, the distance between the inner edges of proximalteeth of iris retractor when slender element is in a maximal extendedorientation, equals to 5.8 to 6.2 mm.

In some embodiments, the distance between the distal ends of eachslender element of the iris retractor when the retractor is in a maximalextended orientation, equals to 2.9 to 9.3 mm. In some embodiments thedistance between the distal ends of each slender element of the irisretractor when the retractor is in a maximal extended orientation,equals to 3.6 to 8.5 mm. In some embodiments, the distance between thedistal ends of each slender element of the iris retractor when theretractor is in a maximal extended orientation, equals to 4.3 to 7.7 mm.In some embodiments, the distance between the distal ends of eachslender element of the iris retractor when the retractor is in a maximalextended orientation, equals to 5.05 to 6.95 mm. In some embodiments,the distance between the distal ends of each slender element of the irisretractor when the retractor is in a maximal extended orientation,equals to 5.8 to 6.2 mm.

In some embodiments, the distance between the inner edges of proximalteeth of iris retractor when retractor is in a maximal contractedorientation equals to 0.07 to 0.38 mm. In some embodiments, the distancebetween the inner edges of proximal teeth of iris retractor whenretractor is in a maximal contracted orientation equals to 0.11 to 0.34mm. In some embodiments, the distance between the inner edges ofproximal teeth of iris retractor when retractor is in a maximalcontracted orientation equals to 0.14 to 0.3 mm. In some embodiments,the distance between the inner edges of proximal teeth of iris retractorwhen retractor is in a maximal contracted orientation equals to 0.16 to0.27 mm. In some embodiments, the distance between the inner edges ofproximal teeth of iris retractor when slender element is in a maximalcontracted orientation equals to 0.18 to 0.23 mm.

In some embodiments, the distance between the proximal end and pivotmember of the iris retractor when the retractor is in a maximal extendedorientation, equals to 0.45 to 1.44 mm. In some embodiments, thedistance between the proximal end and pivot member of the iris retractorwhen the retractor is in a maximal extended orientation, equals to 0.55to 1.34 mm. In some embodiments, the distance between the proximal endand pivot member of the iris retractor when the retractor is in amaximal extended orientation, equals to 0.65 to 1.25 mm. In someembodiments, the distance between the proximal end and pivot member ofthe iris retractor when the retractor is in a maximal extendedorientation, equals to 0.75 to 1.15 mm. In some embodiments, thedistance between the proximal end and pivot member of the iris retractorwhen the retractor is in a maximal extended orientation, equals to 0.85to 1.04 mm.

In some embodiments, the distance between the proximal end and pivotmember of the iris retractor when the retractor is in a maximalcontracted orientation/configuration, equals to 1.47 to 4.56 mm. In someembodiments, the distance between the proximal end and pivot member ofthe iris retractor when the retractor is in a maximal contractedorientation, equals to 1.87 to 4.15 mm. In some embodiments, thedistance between the proximal end and pivot member of the iris retractorwhen the retractor is in a maximal contracted orientation, equals to 2.2to 3.75 mm. In some embodiments, the distance between the proximal endand pivot member of the iris retractor when the retractor is in amaximal contracted orientation, equals to 2.6 to 3.4 mm. In someembodiments, the distance between the proximal end and pivot member ofthe iris retractor when the retractor is in a maximal contractedorientation, equals to 2.8 to 3.3 mm.

In some embodiments, the distance between pivot member and a distal edgeof distal tooth of the iris retractor (such as in FIG. 14) equals to 1.5to 4.74 mm when retractor is in a maximal extended orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) is 1.9 to 4.3 mmwhen retractor is in a maximal extended orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) is 2.3 to 3.9 mmwhen retractor is in a maximal extended orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) is 2.7 to 3.5 mmwhen retractor is in a maximal extended orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) equals to 2.85to 3.3 mm when retractor is in a maximal extended orientation.

In some embodiments, the phrase “slender elements” means slenderelements of a retractor. In some embodiments, the phrase “slenderelements” is synonymous with the term “retractor”.

In some embodiments, the distance between pivot member and a distal edgeof distal tooth of the iris retractor (such as in FIG. 14) equals to2.55 to 7.8 mm when retractor is in a maximal contracted orientation. Insome embodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) equals to 3.15to 7.2 mm when retractor is in a maximal contracted orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) equals to 3.75to 6.6 mm when retractor is in a maximal contracted orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) equals to 4.4 to6 mm when retractor is in a maximal contracted orientation. In someembodiments, the distance between pivot member and a distal edge ofdistal tooth of the iris retractor (such as in FIG. 14) equals to equalsto 4.8 to 5.4 mm when retractor is in a maximal contracted orientation.

In some embodiments, the bulge (see FIG. 14) is a lateral protrusioncoupled to the ear/handle at the proximal portion or proximal end of theretractor and is used for gripping the retractor during insertion to theeye. In some embodiments, the lateral protrusion of the bulge is 0.1 to0.5 mm. In some embodiments, the lateral protrusion of the bulge is 0.18to 0.45 mm. In some embodiments, the lateral protrusion of the bulge is0.23 to 0.4 mm. In some embodiments, the lateral protrusion of the bulgeis 0.25 to 0.4 mm. In some embodiments, the lateral protrusion of thebulge is 0.28 to 0.33 mm.

In some embodiments, the length of the protruding ear of the handle is0.2 to 0.9 mm. In some embodiments, the length of the protruding ear ofthe handle is 0.27 to 0.77 mm. In some embodiments, the length of theprotruding ear of the handle is 0.32 to 0.71 mm. In some embodiments,the length of the protruding ear of the handle is 0.4 to 0.66 mm. Insome embodiments, the length of the protruding ear of the handle is 0.45to 0.58 mm.

In some embodiments, the radius of a protruding ear (see FIG. 14) is 0.5to 1.5 mm. In some embodiments, the radius of a protruding ear (see FIG.14) is 1.1 mm. In some embodiments, the radius of a protruding ear (seeFIG. 14) is 0.8 to 1.0 mm. In some embodiments, the radius of aprotruding ear (see FIG. 14) is 0.86 to 0.9 mm.

In some embodiments, the depth or thickness of two slender elementsequals to 0.4 to 1.8 mm. In some embodiments, the depth or thickness oftwo slender elements equals to 0.6 to 1.5 mm. In some embodiments, thedepth or thickness of two slender elements equals to 0.75 to 1.35 mm. Insome embodiments, the depth or thickness of two slender elements equalsto 0.85 to 1.2 mm. In some embodiments, the depth or thickness of twoslender elements equals to 0.95 to 1.05 mm.

In some embodiments, the depth or thickness of a middle portion of twoslender elements of the retractor equals to 0.2 to 1.2 mm. In someembodiments, the depth or thickness of a middle portion of two slenderelements of the retractor equals to 0.36 to 0.92 mm. In someembodiments, the depth or thickness of a middle portion of two slenderelements of the retractor equals to 0.46 to 0.82 mm. In someembodiments, the depth or thickness of a middle portion of two slenderelements of the retractor equals to 0.5 to 0.75 mm. In some embodiments,the depth or thickness of a middle portion of two slender elements ofthe retractor equals to 0.58 to 0.65 mm.

In some embodiments, In some embodiments, the depth or thickness of theupper (proximal) portion of the slender element (i.e., as held by amedical professional with respect to a treated iris) of two slenderelements of the retractor equals to 0.14 to 0.48 mm. In someembodiments, In some embodiments, the depth or thickness of the upper(proximal) portion of the slender element (i.e., as held by a medicalprofessional with respect to a treated iris) of two slender elements ofthe retractor equals to 0.17 to 0.45 mm. In some embodiments, In someembodiments, the depth or thickness of the upper (proximal) portion ofthe slender element (i.e., as held by a medical professional withrespect to a treated iris) of two slender elements of the retractorequals to 0.2 to 0.42 mm. In some embodiments, In some embodiments, thedepth or thickness of the upper (proximal) portion of the slenderelement (i.e., as held by a medical professional with respect to atreated iris) of two slender elements of the retractor equals to 0.23 to0.38 mm. In some embodiments, In some embodiments, the depth orthickness of the upper (proximal) portion of the slender element (i.e.,as held by a medical professional with respect to a treated iris) of twoslender elements of the retractor equals to 0.25 to 0.32 mm.

In some embodiments, (such as FIG. 14B) the distance (181) between theprotruding ears of a fully expanded retractor is 4-14 mm. In someembodiments, (such as FIG. 14B) the distance (181) between theprotruding ears of a fully expanded retractor is 4-10 mm. In someembodiments, (such as FIG. 14B) the distance (181) between theprotruding ears of a fully expanded retractor is 5-8 mm. In someembodiments, (such as FIG. 14B) the distance (181) between theprotruding ears of a fully expanded retractor is 6-7 mm. In someembodiments, (such as FIG. 14B) the maximal distance (190) between thedistal teeth of a fully expanded retractor is 5-14 mm. In someembodiments, (such as FIG. 14B) the maximal distance (190) between thedistal teeth of a fully expanded retractor is 6-12 mm. In someembodiments, (such as FIG. 14B) the maximal distance (190) between thedistal teeth of a fully expanded retractor is 7-10 mm. In someembodiments, (such as FIG. 14B) the maximal distance (190) between thedistal teeth of a fully expanded retractor is 8-10 mm.

In some embodiments, (such as FIG. 14B) the maximal width of theretractor at the slender elements joining spot (“the neck”) such as thepivot (191) is 0.4-1.4 mm. In some embodiments, (such as FIG. 14B) themaximal width of the retractor at the slenders joining spot such as thepivot (191) is 0.5-1.2 mm. In some embodiments, (such as FIG. 14B) themaximal width of the retractor at the slenders joining spot such as thepivot (191) is 0.7-0.9 mm.

In some embodiments, (such as FIG. 14 (188), FIGS. 9-11) the maximallateral protrusion of the hook or a portion thereof such as a tooth is0.9 mm. In some embodiments, (such as FIG. 14, FIGS. 9-11) the maximallateral protrusion of the hook or a portion thereof such as a tooth is0.8 mm. In some embodiments, (such as FIG. 14, FIGS. 9-11) the maximallateral protrusion of the hook or a portion thereof such as a tooth is0.7 mm. In some embodiments, (such as FIG. 14 (188), FIGS. 9-11) thelateral protrusion of the hook or a portion thereof such as a tooth is0.3-0.9 mm. In some embodiments, (such as FIG. 14 (188), FIGS. 9-11) thelateral protrusion of the hook or a portion thereof such as a tooth is0.5-0.8 mm.

In some embodiments, the maximal diameter of a hook or the maximal widthof a niche bordered by teeth 703 and 704 of a hook (such as in FIGS. 13and 14 (185)) is 0.2-0.9 mm. In some embodiments, the maximal diameterof a hook or the maximal width of a niche bordered by teeth 703 and 704of a hook (such as in FIGS. 13 and 14 (185)) is 0.3-0.8 mm. In someembodiments, the maximal diameter of a hook or the maximal width of aniche bordered by teeth 703 and 704 of a hook (such as in FIGS. 13 and14 (185)) is 0.4-0.6 mm.

In some embodiments, the distance between two proximal teeth of thefully expanded retractor of FIG. 14 (distance 189) is 4-12 mm. In someembodiments, the distance between two proximal teeth of the fullyexpanded retractor of FIG. 14 (distance 189) is 4-8 mm. In someembodiments, the distance between two proximal teeth of the fullyexpanded retractor of FIG. 14 (distance 189) is 5-7 mm.

In some embodiments, the maximal distance between the proximal end tothe distal end of a fully expanded retractor of the invention (such aselement 182 in FIG. 14) is 4-10 mm. In some embodiments, the maximaldistance between the proximal end to the distal end of a fully expandedretractor of the invention (such as element 182 in FIG. 14) is 4-8 mm.In some embodiments, the maximal distance between the proximal end tothe distal end of a fully expanded retractor of the invention (such aselement 182 in FIG. 14) is 4-7 mm. In some embodiments, the maximaldistance between the proximal end to the distal end of a fully expandedretractor of the invention (such as element 182 in FIG. 14) is 5-6 mm.

In some embodiments, the length of the proximal portion of the fullyextended retractor (extending from the pivot to the proximal end, suchas distance 183 in FIG. 14) is 1-6 mm. In some embodiments, the lengthof the proximal portion of the fully extended retractor (extending fromthe pivot to the proximal end, such as distance 183 in FIG. 14) is 1-4.5mm. In some embodiments, the length of the proximal portion of the fullyextended retractor (extending from the pivot to the proximal end, suchas distance 183 in FIG. 14) is 2-4 mm. In some embodiments, the lengthof the proximal portion of the fully extended retractor (extending fromthe pivot to the proximal end, such as distance 183 in FIG. 14) is 2-3.5mm.

In some embodiments, the length of the distal portion of the fullyextended retractor (extending from the pivot to the distal end, such asdistance 184 in FIG. 14) is 1.5-6.5 mm. In some embodiments, the lengthof the distal portion of the fully extended retractor (extending fromthe pivot to the distal end, such as distance 184 in FIG. 14) is 1.5-5.5mm. In some embodiments, the length of the distal portion of the fullyextended retractor (extending from the pivot to the distal end, such asdistance 184 in FIG. 14) is 2-5 mm. In some embodiments, the length ofthe distal portion of the fully extended retractor (extending from thepivot to the distal end, such as distance 184 in FIG. 14) is 25-4 mm.

In some embodiments, such as in FIG. 14 or 14D a fully retracted orclosed retractor of the invention has a maximal width of 5 mm (element1901 in FIG. 14C). In some embodiments, such as in FIG. 14 or 14D afully retracted or closed retractor of the invention has a maximal widthof 4.5 mm (element 1901 in FIG. 14C). In some embodiments, such as inFIG. 14 or 14D a fully retracted or closed retractor of the inventionhas a maximal width of 4 mm (element 1901 in FIG. 14C). In someembodiments, such as in FIG. 14 or 14D a fully retracted or closedretractor of the invention has a maximal width of 3 mm (element 1901 inFIG. 14C). In some embodiments, such as in FIG. 14 or 14D a fullyretracted or closed retractor of the invention has a width of between1.2 to 5 mm (element 1901 in FIG. 14C). In some embodiments, such as inFIG. 14 or 14D a fully retracted or closed retractor of the inventionhas a width of between 1.8 to 4 mm (element 1901 in FIG. 14C). In someembodiments, such as in FIG. 14 or 14D a fully retracted or closedretractor of the invention has a width of between 2 to 3.5 mm (element1901 in FIG. 14C).

In some embodiments, the length of the proximal portion of the fullyretracted or closed retractor (extending from the pivot to the proximalend, such as distance 1903 in FIG. 14C) is 2-10 mm. In some embodiments,the length of the proximal portion of the fully retracted or closedretractor (extending from the pivot to the proximal end, such asdistance 1903 in FIG. 14C) is 3-8 mm. In some embodiments, the length ofthe proximal portion of the fully retracted or closed retractor(extending from the pivot to the proximal end, such as distance 1903 inFIG. 14C) is 3.5-7 mm. In some embodiments, the length of the proximalportion of the fully retracted or closed retractor (extending from thepivot to the proximal end, such as distance 1903 in FIG. 14C) is 3.5-5.5mm.

In some embodiments, the maximal distance between the proximal end tothe distal end of a fully retracted or closed retractor of the invention(such as element 1902 in FIG. 14C) is 5-18 mm. In some embodiments, themaximal distance between the proximal end to the distal end of a fullyretracted or closed retractor of the invention (such as element 1902 inFIG. 14C) is 5-15 mm. In some embodiments, the maximal distance betweenthe proximal end to the distal end of a fully retracted or closedretractor of the invention (such as element 1902 in FIG. 14C) is 7-15mm. In some embodiments, the maximal distance between the proximal endto the distal end of a fully retracted or closed retractor of theinvention (such as element 1902 in FIG. 14C) is 8-12 mm.

In some embodiments, the length of the distal portion of the fullyretracted or closed retractor (extending from the pivot to the distalend, such as distance 1904 in FIG. 14C) is 2.5-9.5 mm. In someembodiments, the length of the distal portion of the fully retracted orclosed retractor (extending from the pivot to the distal end, such asdistance 1904 in FIG. 14C) is 3.5-8.5 mm. In some embodiments, thelength of the distal portion of the fully retracted or closed retractor(extending from the pivot to the distal end, such as distance 1904 inFIG. 14C) is 4-7 mm. In some embodiments, the length of the distalportion of the fully retracted or closed retractor (extending from thepivot to the distal end, such as distance 1904 in FIG. 14C) is 4.5-5.5mm.

In some embodiments, the maximal width of the distal portion (extendingfrom the pivot to the distal end) of a fully retracted or closedretractor (such as in FIG. 14C) is 4 mm. In some embodiments, themaximal width of the distal portion (extending from the pivot to thedistal end) of a fully retracted or closed retractor is 3 mm. In someembodiments, the maximal width of the distal portion (extending from thepivot to the distal end) of a fully retracted or closed retractor is 2mm. In some embodiments, the maximal width of the distal portion(extending from the pivot to the distal end) of a fully retracted orclosed retractor is 1.5 mm. In some embodiments, the width of the distalportion (extending from the pivot to the distal end) of a fullyretracted or closed retractor is 0.3-4 mm. In some embodiments, thewidth of the distal portion (extending from the pivot to the distal end)of a fully retracted or closed retractor is 0.5-2.5 mm. In someembodiments, the width of the distal portion (extending from the pivotto the distal end) of a fully retracted or closed retractor is 0.5-1.5mm.

In some embodiments, the maximal thickness of a fully retracted orclosed retractor of the invention (such as element 1907 in FIG. 14D) is6 mm. In some embodiments, the thickness of a fully retracted or closedretractor of the invention (such as element 1907 in FIG. 14D) is 4 mm.In some embodiments, the thickness of a fully retracted or closedretractor of the invention (such as element 1907 in FIG. 14D) is 3 mm.In some embodiments, the thickness of a fully retracted or closedretractor of the invention (such as element 1907 in FIG. 14D) is 2.5 mm.In some embodiments, the thickness of the proximal end of a fullyretracted or closed retractor of the invention (such as element 1907 inFIG. 14D) is 1-3 mm. In some embodiments, the thickness of a fullyretracted or closed retractor of the invention (such as element 1907 inFIG. 14D) is 0.3-3 mm. In some embodiments, the thickness of a fullyretracted or closed retractor of the invention (such as element 1907 inFIG. 14D) is 0.3-2.5 mm.

In some embodiments, the thickness of a each of the slender elements(such as element 1911 in FIG. 14D) is 0.1-1.4 mm. In some embodiments,the thickness of a each of the slender elements (such as element 1911 inFIG. 14D) is 0.1-0.8 mm. In some embodiments, the thickness of a each ofthe slender elements (such as element 1911 in FIG. 14D) is 0.1-0.6 mm.

In some embodiments, devices of the invention (such as in FIG. 14A) weremade with a spring having differential force (F) along the expansionplane (in grams) according to the measures provided in table 1:

TABLE 1 Expander Distance between Spring force hooks (iris opening)F[gr] x [mm] 2-6 5.7 4-8 5.3 4-8 4.9 5-9 4.5 6-10 4.1 7-11 3.7 8-12 3.39-13 2.9

It will be appreciated by persons skilled in the art that the presentinvention is not limited by what has been particularly shown anddescribed hereinabove. Rather the scope of the present inventionincludes both combinations and subcombinations of the features describedhereinabove as well as modifications and variations thereof which wouldoccur to a person of skill in the art upon reading the foregoingdescription and which are not in the prior art.

What is claimed is:
 1. A retractor comprising: a first slender elementand a second slender element, each slender element comprising: aproximal handle, and a distal grabbing hook having a concave side; and ajoining mechanism operatively coupling the first and second slenderelements, and being configured to endow said retractor with at least twoconfigurations: a retracted configuration and an expanded configuration,wherein: in the retracted configuration, said concave sides of saiddistal grabbing hooks face one another, and in the expandedconfiguration, said concave sides of said distal grabbing hooks faceaway from one another.
 2. The retractor according to claim 1, whereinthe proximal handles are spring-loaded.
 3. The retractor according toclaim 2, wherein said spring is configured to bias said retractor tosaid expanded configuration.
 4. The retractor according to claim 1,wherein the joining mechanism comprises a pivot.
 5. The retractoraccording to claim 3, wherein said pivot defines a narrowest portion ofsaid retractor.
 6. The retractor according to claim 1, wherein thefollowing portions of the retractor, together, are dimensioned such thatthey can be inserted through a 1.5 millimeter incision when theretractor is in the retracted configuration: a distal portion of saidfirst slender element, wherein the distal portion of said first slenderelement is defined as extending from a distal end of the distal grabbinghook of said first slender element to a location where said joiningmechanism is coupled to said first slender element, and a distal portionof said second slender element, wherein the distal portion of saidsecond slender element is defined as extending from a distal end of thedistal grabbing hook of said second slender element to a location wheresaid joining mechanism is coupled to said second slender element.
 7. Theretractor according to claim 6, wherein the proximal handles arespring-loaded.
 8. The retractor according to claim 7, wherein saidspring is configured to bias said retractor to said expandedconfiguration.
 9. The retractor according to claim 6, wherein thejoining mechanism comprises a pivot.
 10. The retractor according toclaim 9, wherein said pivot defines a narrowest portion of saidretractor.
 11. A kit comprising a pair of retractors, wherein each oneof said retractors is the retractor of claim
 1. 12. A kit comprising apair of retractors, wherein each one of said retractors is the retractorof claim
 2. 13. A kit comprising a pair of retractors, wherein each oneof said retractors is the retractor of claim
 3. 14. A kit comprising apair of retractors, wherein each one of said retractors is the retractorof claim
 4. 15. A kit comprising a pair of retractors, wherein each oneof said retractors is the retractor of claim
 5. 16. A kit comprising apair of retractors, wherein each one of said retractors is the retractorof claim
 6. 17. A kit comprising a pair of retractors, wherein each oneof said retractors is the retractor of claim
 7. 18. A kit comprising apair of retractors, wherein each one of said retractors is the retractorof claim
 8. 19. A kit comprising a pair of retractors, wherein each oneof said retractors is the retractor of claim
 9. 20. A kit comprising apair of retractors, wherein each one of said retractors is the retractorof claim 10.